Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. North Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Unc Physicians Network LLC (NPI 1558786830)

Key Findings

Field	Value
Entity Type	Organization
Organization	Unc Physicians Network LLC
Address	5221 Paramount Pkwy Ste 220
City	Morrisville
State	NC
ZIP	27560
Taxonomy	General Practice Physician
NPI Enumerated	February 24, 2014

Payer Source	Total Paid
Medicaid	$47M
Medicare	$0

UNC PHYSICIANS NETWORK LLC is effectively a single‑payer Medicaid operation: Total Medicare revenue is listed as none (no Medicare billing on file) while Total Medicaid revenue is $47M. This concentration means all measurable fee‑for‑service activity in our dataset is driven by Medicaid flows, so payer‑mix discussions should treat this entity as Medicaid‑focused rather than a dual Medicare/Medicaid practice.

Revenue is highly concentrated in a small set of service codes: the precomputed top three Medicaid codes account for 68.6% of the provider's total Medicaid revenue. The three leading codes are 99213 ($10.9M, 25.5% of Medicaid revenue), 99214 ($10.8M, 25.3%), and 99199 ($7.6M, 17.8%), indicating that the vast majority of dollars come from evaluation/management visits and a large category of 'other medicine services'.

The code mix points to a high-volume ambulatory primary care footprint with broad preventive and pediatric services. High revenue and claim counts for E/M codes 99213 (265K claims) and 99214 (196.3K claims), plus substantial pediatric/preventive codes such as 90460 (42.6K claims, $1.8M) and 99391/99392/99393, indicate routine office visits, immunizations, and well‑child/adolescent checks are central to operations.

Several codes show exceptionally large in‑state market share for their categories, reflecting a dominant statewide position on core ambulatory services. 99213 ranks #4 of 4130 providers in‑state (100th percentile; extreme outlier) and 99214 ranks #3 of 4404 providers (100th percentile; extreme outlier), while 99199 ranks #10 of 2853 providers (100th percentile; extreme outlier). These rank/percentile patterns portray UNC PHYSICIANS NETWORK LLC as a major, high‑volume provider for routine outpatient E/M and uncoded/other medicine services within North Carolina.

The practice also appears to deliver a broad clinical mix beyond standard office visits, including procedural, inpatient follow‑up, and diagnostic testing lines. Notable entries include 20610 (14.3K claims, $299.5K revenue) ranked #1 of 143 in‑state (100th percentile; extreme outlier), inpatient follow‑up codes 99232/99233 with elevated volumes, and multiple infectious‑disease testing codes (87637, 87428, 87426, 87880) showing meaningful Medicaid revenue contributions, which together suggest ancillary procedural and testing capacity co‑located with ambulatory care.

High claim volumes on a low‑priced catch‑all code (99199 with 1.5M claims at $5 avg paid/claim generating $7.6M) indicate extensive use of other/unspecified medicine entries. Because 99199 comprises 17.8% of Medicaid revenue and is labeled an extreme outlier in the state, analysts should review service documentation and coding practices for this category when assessing service mix and revenue drivers.

The provider’s operational footprint includes robust preventive and pediatric activity: 90460 (vaccine administration) generates $1.8M (4.2% of Medicaid revenue) and preventive E/M codes 99391/99392/99393 together contribute materially to revenue. These data points align with a practice that sees a high volume of children and adolescents and performs routine immunizations and well visits at scale.

Tenure and stability in the claims file are established: the NPI was enumerated on 2014-02-24 (~12 years ago). Combined with consistently high statewide ranks across many codes (multiple 100th‑percentile and other top‑percentile standings), this suggests an established organization with sustained high Medicaid‑volume operations rather than a recent or transient spike in activity.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

270 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	265,020	$40	$10.9M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	196,320	$60	$10.8M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	1,512,910	$10	$7.6M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	42,630	$40	$1.8M
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	19,270	$60	$1.1M
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	9,490	$120	$1.1M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	32,890	$30	$1.1M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	12,890	$90	$1.1M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	11,550	$90	$1.1M
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	10,330	$90	$940.2K

Showing 1–10 of 270

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. North Carolina Distribution

Unc Physicians Network LLC — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

270 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	208	330	6,130	$130	$2.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	252	320	6,160	$120	$2.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	239	280	2,690	$130	$1.6M
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	28	30	50	$620	$410.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	121	150	1,340	$80	$395.9K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	19	20	2,270	$90	$369.8K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	7	90	250	$110	$352.3K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	13	50	70	$1,220	$332.9K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	10	2,850	10,910	$10	$330.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	41	60	1,440	$110	$309.4K

Showing 1–10 of 270

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Of North Carolina At Chapel Hill	NC	Anesthesiology Physician	$0	$87.6M
University Of North Carolina Hospitals At Chapel Hill	NC	General Acute Care Hospital	$0	$50.7M
Caldwell Memorial Hospital, Inc.	NC	General Acute Care Hospital	$0	$28.8M
Rex Hospital Inc.	NC	General Acute Care Hospital	$0	$25.3M
Clinton Medical Clinic, Inc.	NC	General Practice Physician	$0	$17.3M
Unc Rockingham Health Care, Inc.	NC	General Acute Care Hospital	$0	$10.3M
University Of North Carolina Hospitals At Chapel Hill	NC	Durable Medical Equipment & Medical Supplies	$0	$7.8M
Caldwell Memorial Hospital, Inc	NC	Pediatrics Physician	$0	$7.3M
John Deans	NC	Ophthalmology Physician	$2.4M	$0
Rex Hospital, Inc.	NC	Land Ambulance	$1M	$204K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Uwh Of The Carolinas, PLLC	NC	Obstetrics & Gynecology Physician	$0	$14.9M
Andor Labs LLC	NC	Clinical Medical Laboratory	$1.9M	$11.2M
Associated Health Services, Inc.	NC	Ambulatory Surgical Clinic/Center	$3.5M	$48.5K
Duke University Health System Inc	NC	Diagnostic Radiology Physician	$321.7K	$11.2K
National Mobile X-ray LLC	NC	Physiological Laboratory	$174.3K	$13.1K
Adedayo Ashana	NC	Orthopaedic Surgery Physician	$181K	$0
Matthew Plymyer	NC	Anatomic Pathology & Clinical Pathology Physician	$81.5K	$0
David Ruch	NC	Orthopaedic Hand Surgery Physician	$71.7K	$0
Marc Richard	NC	Orthopaedic Hand Surgery Physician	$56K	$0
Hayden Joseph	NC	Orthopaedic Surgery Physician	$52.7K	$0

Unc Physicians Network LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References